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Detection of Postoperative Deep-Venous Thrombosis Using Technetium-99m-Labeled Tissue Plasminogen Activator

Department of Nuclear Medicine, St. George Hospital, Sydney, Australia

Correspondence: For correspondence or reprints contact: S. P. Butler, MD, Dept. of Nuclear Medicine, St. George Hospital, Sydney 2217, Australia.

ABSTRACT

The current noninvasive methods of deep-venous thrombosis (DVT) detection in the asymptomatic patient are sufficiently inaccurate so as to preclude their routine use. This present study reports the accuracy of scintigraphic scanning with ^99mTc-rt-PA in asymptomatic postoperative patients using contrast venography as the gold standard. Methods: Fifty-three consecutive postarthroplasty patients (30 THR, 23 11 TKR)(16 women, 37 men; mean age 71 yr, range 52-85 yr) underwent scintigraphic scanning with ^99mTc-rt-PA and contrast venography, on the operated leg, in order to assess the accuracy of this new technique in these asymptomatic patients. Results: Eighty-four segments were of diagnostic quality on contrast venography. Of the 15 thrombosed segments, 14 had positive scans. In the 69 nonthrombosed segments, 63 had negative scans. Thus, scintigraphic scanning with ^99mTc-rt-PAhad a sensitivity of 93% and a specificity of 91%. Conclusion: This study demonstrated that scintigraphic scanning with modified ^99mTc-rt-PA is accurate in the detection of DVT in patients undergoing total hip or total knee arthroplasty.

Key Words: technetium-99m • recombinant tissue plasminogen activator • deep-venous thrombosis

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